22 September, 2005

The dead, one gets used to seeing. Viewing a recently deceased person, touching a rapidly cooling body through gloved hands, even sometimes hearing the last inhaled air exit the body as I turned a decedent over to examine them took awhile longer to grow accustomed to. The recency of the departed life can often have a strong impact on even the strangers who are present.

Actually watching someone die is a different experience entirely. I never did acquire any level of comfort with this. I’ve lost a number of loved ones, but with none of them was I present for their actual death. I know plenty of people who have experienced this and found it somewhat peaceful - while still deeply sad - to be with a person drawing his or her last breath. Watching someone die violently is vastly different, of course. I have not witnessed a violent death in person – only on videotape. That is more than enough for me.

One videotape was from scene I personally worked. I was called out around 4:30 AM to a convenience store where the clerk had been found dead with no apparent injuries. The scene appeared non-violent and unremarkable with two exceptions: the emergency phone was off the hook, and a partially eaten English muffin breakfast sandwich was sitting next to the microwave behind the counter.
No signs of violence at the scene. No external injuries to the decedent. He was a moderately obese middle-aged man – potential candidate for natural disease such as myocardial infarction (heart attack), cerebral vascular accident (stroke), and the like. He was warm to touch, no rigor mortis, very early blanching livor mortis (blood settling to the dependent portions of the body). He had several missing teeth.

No resuscitation attempts as reported by medics. The consensus being tossed around by police was “heart attack.”

Not so fast, guys. He had been eating - a more important clue than one might think. Eating, missing teeth, phone off the hook; I was concerned about this.

A store manager arrived and pulled the surveillance tape. The tape revealed that the man had indeed been alone, heated up his sandwich, took a bite or two, then appeared to be choking. After what seemed like an endless amount of time (probably to him as well), during which he picked up the emergency phone and attempted to force the food bolus from his trachea by slamming himself into the countertop, he collapsed. What a horrible way to die.

To further add to this tragedy, it was later discovered that his missing teeth were the result of a recent pistol-whipping that occurred while he was working at another convenience store. As a result, he was moved to different branch in a safer area.
Cause of death: a) Asphyxiation b) Choking
Manner of death: Accident

The two people I watched die in person both died in a hospital, and both were transplant cases. I’m a huge believer in organ, bone, and tissue donation, and even worked as a tissue recovery specialist in Kansas City for awhile. It’s important to share this as my intention is not to scare anyone away from the idea of donation or the process itself. It can be fairly brutal to watch due to the time-sensitivity issue of certain living organs.

The first case of this nature I had was a college student who, at the persuasion of her boyfriend, tried heroin for the first time with him. The result was a coma from which she never awakened. After she was declared brain dead (over a period of days, possibly even weeks), the family signed the organ donation papers. In our office, it was standard practice that, if at all possible, an investigator be present during the organ recovery to document postmortem alterations to the body (like incisions, etc.). I had scrubbed in and assisted with a liver recovery once before, and this was a finely-tuned surgical procedure quite unlike autopsies. This organ recovery was nothing like either.

First of all, the transplant procurement specialists are required to leave the OR before the life support machines are turned off and remain outside the OR for a set period of time (I think it was 10 minutes) after the patient is pronounced dead. So the machines were shut off, one by one, while every action was documented. I stood behind her head, and I remember watching the monitors and thinking “Come on – breathe on your own” – as though I could help will her heart to keep up the life-sustaining rate. It did not, and after a few minutes, she was pronounced dead.

When the transplant team came in, it was clock-watching time. It seemed, from my point of view, that they ripped into her chest wall. I know that from a technical perspective, it was much more precise than this, but watching them wield scalpels faster than I ever knew was possible while packing ice into the chest cavity was unlike anything I had yet seen.

I take comfort, as I hope her family and friends did, knowing that her donation saved and/or improved the lives of others.

The second was very much like the first, and the circumstances were also heartbreaking. I will relay the story of a multiple shooting in another chapter. See the upcoming “contagious waste disposal” for full description.

21 September, 2005

During those late-night discussions we’ve all probably had, the question of the best and worst ways to die arise. Various methods of suffocation seem to be near the top of the "worst" list, according to many people I’ve spoken with about this. I’d have to agree; I know I feel at least a mild surge of panic if someone even playfully puts a pillow over my face. Being buried alive, and not just Poe-style, has to be a torturous affair as well.

I’ve seen some strange burial suffocation deaths, and I’ll relate two of them in reverse order of occurrence.

The second “burial” I investigated was the scene of a construction site. A building was being modified, and both indoor and outdoor construction had been ongoing for some months. Outside, trenches for pipes were being dug.

Trench Digging Rule 1: Always shore up the sides of your trench so they don’t collapse on you.Trench Digging Rule 2: Probably one should not do this kind of work under the influence of a mind-altering substance.

I’m sure OSHA states it more eloquently, but you get the idea.The trench walls caved in on him quickly. He was only buried up to his upper chest (I say “only”), but the pressure was enough to prevent him from expanding his diaphragm to get air. Co-workers were unable to dig him out quickly enough, as the walls kept falling.

Cause of death: AsphyxiationManner of death: Accident (Industrial)

The other "burial" - and this one occurred first - was in one of the few rural areas of the county. I arrived at work and was greeted by Dr. Dimitri Contostavlos, our medical examiner, with (and, containing no prelude whatsoever, typical of his conversation style):“Happy Birthday, young woman. They’re re-enacting the movie Witness in Birmingham Township. Go investigate.” (Translation for those who haven’t seen Witness, and don't mind spoilers, near the end of the movie, a villain is buried in a grain silo.)

That’s exactly what happened at this scene, minus the villain, but including the cameras. Two elderly farmers’ attempts to empty a silo filled with corn went horribly wrong (I won’t bother explaining the detailed mechanics of how it happened.) The grain was released very quickly onto of the farmers inside the silo. The other farmer (his brother), made every effort to pull him out, not knowing his foot was trapped in the auger. The decedent eventually suffocated. I will not soon forget the details of the corn kernel imprints covering his skin, his shoes.

The scene itself was a near circus. I cannot even name all of the investigating agencies present all these years later. I do remember the immense respect I felt for the logistics agent coordinating it all, keeping everyone safe, etc. It was not a good place to be, for anyone; the heat, the poor air quality inside the silo making investigation difficult, the decedent’s brother’s state of mind, and all of our absolute feeling of inefficacy in alleviating his apparent grief and guilt. The press helicopters stirring up dust and tempers did nothing to help.

As you might imagine, neither of these men died quickly or painlessly. We had a saying in our office: “no one ever dies a painful death.” This was, of course, not a credo or a philosophy we implemented when having discussions with decedents’ loved ones; rather it was a way of us dealing with the fact that often people do suffer in the perimortem interval, and discussing that with family is a very touchy issue. An investigator must maintain high standards of honesty, objectivity, and tact, and oftentimes it is difficult to simultaneously adhere to all three standards.

This puts the investigator in a precarious position should a family member ask “Did he suffer?” Responding with “Yes, he was slowly crushed to death or and was probably conscious for much of it” is not acceptable, obviously. Much of the time, the suffering is self-evident. If an investigator is wholly honest with anyone who asks, it should be stated that there are many unknown factors; investigators and medical examiners usually cannot tell if or for how long someone is conscious or acutely aware of pain during the dying process. I could speculate, just like the loved ones inevitably do, but I didn’t voice these speculations.

But those speculations and re-creations were turned inward – and the primary difference, other than me possessing objectivity because the decedents were not people I knew - was made up for in empathy and knowledge. I know the anatomical mechanics and the physiological processes that occur during suffocation – or most deaths. I know what systems are breaking down and how those manifest. Having seen and analyzed the results, I can realistically imagine the suffering. And after my eyes shut, I often do.

16 September, 2005

The death of an infant or child is never easy for anyone involved. Even with the death of a terminally ill child, there is rarely any comfort, sense of timeliness or justice – rather there exists only pain, despair, and guilt.

I came to understand that for a parent, in the death of a child, age is incidental; most parents simply do not expect to outlive their children. This chapter, however, is about my experiences with the deaths of infants and very young children.

From a knowledge standpoint, I was fortunate to gain the experiences I had. I had the distinction of being the infant and child death specialist in our office. I served on the Child Death Review Team for the county, which provided one of the few proactive outlets I had as an investigator; this was good.

From a mental health perspective, however, fortunate is not the most accurate descriptor. I would not erase or alter these trying experiences. The long-term effects for me, the consummate introvert, arrive belatedly, though, so truly “dealing” with tragedy – be it peripheral or first-hand – is a prolonged and complicated process. In other words, I left my position in forensics in 2001, and only after several years did the proverbial ghosts begin to manifest. I do not think I am balancing on the cusp of lunacy (or if I am, it is not because of working with the dead), but I am self aware enough to know when an exorcism is in order.

For death investigators, there are always cases that test our limits and push relentlessly into the wounds of our weaknesses.
During my first month at the office, a colleague and I were called to a scene where a deceased newborn was found wrapped in plastic and stowed in a cooler in the attic of a family home. The child was well preserved but had obviously been in this place for years. It was never determined whose child this was or what the circumstances of the child’s birth were, but it was determined that the fetus was in all likelihood viable, that is, not stillborn.

Several years later, the same colleague responded to the scene of a young boy (around 18 months) who died suddenly. From what I recall, the only external sign of trauma visible was a very deep incised wound on one of his fingers. The autopsy revealed that he died of asphyxiation caused by a blood-soaked paper towel forcibly inserted into his throat and sinus cavities. Further investigation revealed that the child had injured his finger (how is unknown to me), his mother wrapped the finger in a paper towel, and in an effort to quiet him, forced the paper towel into his mouth and he aspirated it. His mother had several older children and was pregnant at the time.

I’m not sure I can adequately express my reaction to this situation or to the fact that circumstances such as these are all too common. Anger doesn’t begin to describe the wave that hit when this child’s autopsy findings were revealed. My colleague was near emotional paralysis for a short time; I will delve into the debriefing we investigators practiced in other chapters, but for now, suffice it to say we were all affected. A different breed of people may not have channeled it as productively, fairly, and efficiently as the people I worked alongside. For their enduring strength and reason, I will always be grateful, as should the residents of Delaware County.

I have heard a great deal of discussion about parental rights and the ensuing counter arguments for child advocacy. I don’t know what is morally correct, to be honest, but I know which side I favor.

How are these two cases related? They aren't, except in that they happen to be two of many involving a concept I refer to as "disposable children." Is there not enough waste and suffering in the world?

It was never about the autopsies for me. That is the “interior business,” in the most pragmatic sense of the term - inside the body, inside the autopsy suite. I learned a vast amount from assisting with autopsies, unquestionably, and I enjoyed the interior work for that reason.

Despite that, for me, it was always about the scene. The investigation. The puzzle-solving.From the time each call came in, my brain shifted gears, and didn’t shift back until some undetermined time after the scene investigation ended. I found that trying to shut off my mind after a 40-hour weekend was next to impossible. I also found that, despite the sleep deprivation, most of the time I didn’t want to shut it off.

It is still not entirely shut off in this sense. I still don’t want it to be. It has had so much of an impact, that while I do not usually initiate or encourage conversations about my scene work, it has profoundly affected who I am, and in the most private of ways. I don’t think most people who know me – even those few with whom I am very close - understand this.

I determined very early in my career that it is crucial not to take any scene for granted, no matter how simple or complex it appeared. Along those lines, another crucial lesson learned was that while it is imperative for a good investigator to listen and give credence to the opinions of others present (police, paramedics, family, friends, witnesses), the investigator must ultimately use his or her own expertise, sense, and background when applying the cumulative information to the scene at hand. Circumstances of death are not always as they appear. I cannot stress this enough.

Case example:1) Background: female, early 50s, lived alone, found dead by an adult offspring, house secure. At the time of the report, medical history was unknown. I arrived on scene. There was blood everywhere -or so it seemed- in the master bedroom and bathroom. Bed, floor walls, furniture were splattered and soaked. A bucket in the bedroom contained more blood – substantially more. Cursory external examination of the body revealed no external signs of trauma. The paramedic presented his interpretation (medical cause of death); the police officer voiced skepticism of this and his own interpretation (suspicious cause and manner of death). After speaking with family, I learned that the medical history included severe, long-term alcohol abuse.While it is not the investigator’s role to determine final cause and manner of death, it is important to have a pretty clear idea of likelihood. I will say this: the scene looked like a violent homicide. I understood why the investigating officer was uncomfortable. But it was the paramedic who was on target with his medical assessment, and after weighing all of the scene evidence, this was the direction I went. The scene evidence and investigative findings were later backed up by autopsy and pathology findings.

This was an interesting scene. It was also tragic – for all appearances, this seemed to be a woman with loving children, a nice home, and little medical history other than alcoholism, which was certainly enough. I learned that this woman hid her alcoholism from nearly everyone, though her family knew.

So much lurks beneath the surface in each of our lives. We all hide various aspects of our personalities, deepest thoughts, habits, and behaviors. In death, nearly all that we have so carefully sheltered in life is revealed, and in the barest, most unflinching ways.

15 September, 2005

As with the first autopsy, the first scene I attended as an intern is not easily forgotten.

I remember we (the staff) were in the autopsy suite doing the initial external examination of a pedestrian vs. train (the train won, but pedestrian was remarkably intact), when a call came in; an elderly woman was found deceased in her home.

The on-call investigator and I responded to the scene, and arrived to find that the county Criminal Investigation Division (CID) had broken into the home after neighbors reported the telltale foul odor - a concept with which I would become all too familiar. It was June, and she had been deceased for several days.

After performing the necessary photography and background work, cursory external examination of the body, search for signs of medication and next of kin information, four of us attempted to remove this bloated woman from her living room chair (where she had evidently died peacefully) and place her in a body bag. A CID intern from Penn State was present and attempted to assist; fortunately, three of us were able to handle the decedent after this student bolted out the door to vomit in the back yard. The investigator from our office used this as bragging rights about me for months thereafter ("CID's guy puked and our girl didn't"). It was a strange form of flattery, but I appreciated it all the same.

I quickly learned that this scene was somewhat typical for a natural death, minus the decomposition factor, which certainly wasn’t unusual but wasn’t the norm, either. In retrospect, it saddens me to think of how many people die alone, and even more so to think about how many of them are not found for days…or even longer. I’m not very sentimental about what happens to the body after death. What is troubling is what the circumstances surrounding someone's death can say about that particular life. Throughout the years, scene after scene, I observed many signs of isolation, and not just advanced decomposition (which can be caused by a number of factors). Piled-up mail and newspapers, neglected pets, and spoiled food can provide valuable clues to investigators, but also telling disclosures about an individual’s life...and ultimately, that person's death.

Sometimes people ponder what his or her own funeral might be like: who will attend, what will be said in a eulogy, etc.? My scene experiences yielded a different perspective; I now think about who will find me, when, and how. Will I allow my introversion to isolate me to the point of being someone who is not missed for a long period of time? I cannot rule this out. I know this: if I have any control over the timing or mechanism of my own death (which is doubtful), I will consider who I am leaving behind, and not just people who know me. I’d like to think I can maintain my independent nature throughout life but still have enough ties to have at least one person who notices an absence or extreme variance in routine should my sudden death occur. I am also aware that given my propensity to withdraw, it is a very real possibility that should I die at home alone at an advanced age, it will very likely not be noticed quickly.

For five years during my mid to late twenties, nearly every day was fraught with the intricacies of deaths of the citizens in a county adjacent to Philadelphia, Pennsylvania.

I chose this. To me, this was the most relevant, logical, and exciting career path for someone with my educational focus. It combined the bulk of my studies, from the criminology/justice studies major to the sociology and anthropology minors, the almost psychology minor, and even the biology, anatomy, physiology I made time to take. When the Delaware County Medical Examiner’s Office accepted my internship application during my senior year undergraduate studies, I was determined to turn the opportunity into more than simply part of my college experience.

The internship and job that followed primarily entailed responding to, investigating, and following up on reported deaths. As an intern, I began by shadowing the investigators, observing autopsies, and reading reports. Procedurally, when a police department, paramedic, 911 operator, or hospital employee contacted the on-call investigator to report a death, the investigator first determined the next appropriate steps.

From the time I was hired and for the majority of my tenure, our office was comprised of four investigators, one medical examiner, one autopsy technician, and one secretary, although this fluctuated to some extent during the last two years I was there. What that means is this: four investigators and one pathologist oversaw all reportable deaths in a county of about half a million residents, and di so twenty-four hours a day, every day of the year. The adage that death never takes a holiday is certainly true. Occasionally, death investigators take holidays, but not without coverage.

Delaware County, PA is geographically small and demographically varied. In what ways this is true shall be revealed throughout the cases and experiences disclosed, but it is an important observation, particularly from a girl from rural northeastern Kansas.

The first autopsy I ever witnessed as an intern I will not soon forget.

A brief case history: 37 year old Caucasian female, moderately obese, history of seizure disorder, found dead at home, no external signs of trauma, no suspicious circumstances.

My observations: Adipose tissue (fat) is a brighter yellow than I had imagined. Intestines smell about the way I imagined. The human liver is huge. The right lung is visibly larger than the left lung. The face is peeled back during an autopsy in a very efficient manner to allow access to the skull and brain. (And if done correctly, most people would never know it during a funeral viewing, which still amazes me.) Blood against stainless steel produces a nasty metallic pungency that left me glaring at my kitchen sink for weeks.

Cause of death: Seizure Disorder

Manner of death: Natural

I did not experience nausea, dizziness, or vomiting during or after observing the autopsy. I also did not eat particularly well that evening; of course, my then significant other chose that night to make breakfast for dinner. Eggs and sausage may have been the single worst choice of meals on that day. My sleep was undisturbed that night.

"Grave Wisdom" title credit to Skinny Puppy. Subsequent chapter titles taken from song lyrics of said title.

Upon discovering this, many people have said to me: "You really should write a book about it!” After leaving the field, my standard response became: "Yeah, you know what? I really should.”

As is human nature, words and actions often fail to intersect, and I spouted this well-intentioned yet dismissive response for years. But I did think about it.

Although writing has been a passion since I can remember, it took a long time for me to truly want to apply my stories from the forensic world to a literary medium. I discussed some industry details in a local newspaper and television interview in August, 2004, and through this learned that while I do pretty well in print, I’m appallingly bad on television. Still, this sparked a chain of important events in my life, and prompted me to finally do more than think about cataloging my venture into death investigation.

I am finally writing about this. While I am using real cases (they are public record), I am divulging personal details about myself, former colleagues, and experiences that are often subjective. For that reason, I am protecting and even omitting some names. The accounts are as scientifically factual as I can make them, but they are told from my point of view and include my interpretations of and reactions to each situation.

The public arena will hopefully keep me accountable enough to continue this endeavor. For those readers who find graphic accounts of death or loss upsetting, I do not recommend reading this blog. My hope is that anyone who does read these memoirs finds them interesting and meaningful, however, they are ultimately for me. The memories are ingrained in me. The experiences have shaped me. I cannot fathom who I might be without this in my past. All that said, sometimes even the most profound experiences can leave traces that must be cleansed. This is my exorcism.